Elbow forearm and wrist THIS IS AN AXIAL

Elbow, forearm and wrist

THIS IS AN AXIAL IMAGE ABOVE THE LEVEL OF THE ELBOW JOINT, MEDIAL IS THE BOTTOM OF THE IMAGE, LATERAL IS THE TOP OF THE IMAGE, VENTAL (ANTERIOR) IS TO THE RIGHT AND DORSAL (POSTERIOR) IS TO THE LEFT FIRST, LETS TRY AND IDENTIFY SOME OF THE MAJOR MUSCLE WE ARE LOOKING AT. IF YOU FLEX YOU ARM WHAT MUSCLE DO YOU FEEL? HOW ABOUT WHEN YOU EXTEND IT? GO AHEAD GIVE YOUR ARM A GRAB BICEPS ON FLEXION AND TRICEPS ON EXTENSION IF YOU FEEL THE MEDIAL SIDE OF YOU BICEPS, DO YOU FEEL A PULSE? WHAT VESSEL IS THIS? AND FOR EXTRA CREDIT WHAT NERVE RUNS WITH IT? BRACHIAL ARTERY AND VEIN WITH THE MEDIAN NERVE T B

WE ARE JUST ABOVE THE ELBOW JOINT WHAT HAS HAPPENED TO THE BICEPS MUSCLE? AGAIN GIVE YOUR ARM A FEEL. IT IS NOW TENDON, NOTE ITS RELATIONSHIP TO THE MEDIAN NERVE AND BRACHIAL NEUROVASCULAR BUNDLE WHAT OTHER MAJOR NERVES DO YOU EXPECT TO SEE IN THE ARE AT THIS LEVEL? RADIAL AND ULNAR NERVES. CAN YOU FIND THEM? TENDON RADIAL (WHITE ARROW) ULNAR (BLACK ARROW) FOR EXTRA CREDIT WHAT ARE THE 2 MUSCLES THE BORDER THE RADIAL NERVE? BRACHIORADIALIS AND BRACHIALIS, CAN YOU FIND THEM? NVB

NOW WE ARE JUST ABOVE THE LEVEL OF THE ELBOW JOINT, AGAIN IDENTIFY THE BICEPS TENDON, THE BRACHIAL ARTERY AND VEIN, MEDIAN NERVE AND THE BICEPS TENDON AND THE RADIAL ARTERY. WHERE IS THE ULNAR NERVE AND WHAT DO WE CALL IT IN THIS AREA? HINT IT IS NOT FUNNY. THIS IS THE ULNAR NERVE IN THE CUBITAL TUNNEL ALSO KNOWN AS YOUR “FUNNY BONE”. THE NERVE IS VERY SUPERFICIAL IN THIS AREA, TRY AND FEEL YOURS WHY DOES IT LOOK LIKE THIS PATIENT HAS CRACKS IN HIS BONES? THESE ARE GROWTH PLATES IN A SKELETALLY IMMATURE PERSON, THERE A LOT AROUND THE ELBOW

HERE WE ARE AT THE LEVEL OF THE JOINT, AGAIN IDENTIFY ALL OF THE PREVIOUSLY IDENTIFIED STRUCTURES. BRACHIAL ARTERY AND VEINS, MEDIAN NERVE, BICEPS TENDON, RADIAL ARTERY AND ULNAR NERVE IN THE CUBITAL TUNNEL. VENOUS ANATOMY IS EXTREMELY VARIABLE BUT SEE IF YOU CAN IDENTIFY THE CEPHALIC VEIN, MEDIAL CUBITAL VEIN AND THE BASILIC VEIN C B M

HERE WE ARE BELOW THE LEVEL OF THE ELBOW JOINT. WHAT IS HAPPENING TO THE BICEPS TENDON AND THE BRACHIAL ARTERY? THE BICEPS TENDON IS INSERTING ON TO THE RADIAL TUBEROSITY THE BRACHIAL ARTERY IS SPLITTING INTO THE RADIAL AND ULNAR ARTERIES RADIAL ARTERY ULNAR ARTERY

THIS IS AN IMAGE IN THE PROXIMAL FOREARM. TO ORIENT YOU THE RADIUS AND THE ULNA AS WELL AS THE FLEXOR (VOLAR) AND EXTENSOR (DORSAL) SURFACES ARE LABELED. CAN YOU FIND THE RADIAL ARTERY? EXTENSOR HOW ABOUT THE ULNAR ARTERY? CAN YOU IDENTIFY SOME OF THE EXTENSOR MUSCLES BRACHIORADIALIS EXTENSOR CARPI RADIALIS LONGUS BRACHIO ECRL ECRB ED EDM R ECU U EXTENSOR CARPI RADIALIS BREVIS EXTENSOR DIGITORUM EXTENSOR DIGITI MINIMI EXTENSOR CARPI ULNARIS FLEXOR

NOW WE ARE AT THE LEVEL OF THE MID FOREARM. AGAIN IDENTIFY THE REGIONS OF THE ULNAR AND RADIAL ARTERIES. WHAT NERVES RUN WITH THESE VESSELS? ULNAR ARTERY => ULNAR NERVE RADIAL ARTERY => SUPERFICIAL BRANCH OF THE RADIAL NERVE WHAT ARE THESE OTHER 2 NEUROVASCULAR BUNDLES? GREEN =>ANTERIOR INTEROSSEOUS ARTERY AND NERVE FROM MEDIAN NERVE YELLOW => POSTERIOR INTEROSSEOUS ARTERY AND NERVE FROM DEEP BRANCH OF THE

NOW WE ARE IN THE DISTAL FOREARM, AGAIN NOTE THE POSITIONS OF THE ULNAR AND RADIAL ARTERIES. LET’S TAKE A LOOK AT SOME OF THE MUSCLES OF THE FLEXOR COMPARTMENT AT THIS LEVEL. FIND THE FLEXOR POLLICIS LONGUS AND THE FLEXOR CARPI RADIALIS FLEXOR DIGITORUM SUPERFICIALIS AND PROFUNDUS FLEXOR CARPI ULNARIS FPL FCR FDP FDS FCU

NOW WE ARE A FEW CMS PROXIMAL TO THE WRIST JOINT, AGAIN THE RADIUS AND ULNA ARE LABELED FOR YOU. CAN YOU DETERMINE MEDIAN WHICH IS THE FLEXOR AND EXTENSOR NERVE SURFACES BY THE SIZE OF THE MUSCLES. HINT, FEEL YOUR WRIST NOW TRY AND FIND BOTH THE RADIAL AND ULNAR ARTERIES. FEEL YOUR OWN RADIAL AND ULNAR PULSES AS A GUIDE NOW THAT YOU HAVE YOUR BEARINGS, WHAT IS THIS ROUND TUBULAR STRUCTURE BETWEEN THE FLEXOR POLLICIS LONGUS, FLEXOR CARPI RADIALIS TENDON AND THE FLEXOR DIGITORUM SUPERFICIAILIS HINT, IT CAUSES PROBLEMS WITH CARPAL TUNNEL SYNDROME EXTENSOR R FPL U R FCR FDS U FLEXOR

NOW WE ARE JUST PROXIMAL TO THE LEVEL OF THE WRIST JOINT. THE EXTENSOR TENDON ARE DIVIDED INTO 6 COMPARTMENTS #1 BEING ON THE RADIAL SIDE AND #6 BEING ON THE ULNAR SIDE. THERE IS A BONY RIDGE IN THE DORSAL ASPECT OF THE RADIUS THAT HELPS US DIVIDE THESE COMPARTMENTS CALLED LISTER’S TUBERCLE DO YOU SEE IT? NOW TRY AND DIVIDE THE EXTENSOR COMPARTMENTS. COMPARTMENT 1 COMPARTMENT 2 COMPARTMENT 3 COMPARTMENT 4 COMPARTMENT 5 COMPARTMENT 6 TO REVIEW YOUR ANATOMY LOOK UP THE COMPONENTS OF THESE EXTENSOR COMPARTMENTS LT

NOW WE ARE JUST DISTAL TO THE WRIST JOINT. TRY AND LOCATE THE RADIAL ARTERY, ULNAR NERVE AND MEDIAN NERVE CAN YOU FIND THE FLEXOR RETINACULUM? HINT IT IS JUST SUPERFICIAL TO THE MEDIAN NERVE Radial artery THIS THIN BLACK LINE IS THE FLEXOR RETINACULUM AND THIS IS WHAT IS CUT WITH A CARPAL TUNNEL RELEASE Median nerve Ulnar artery and nerve

NOW WE ARE MORE DISTAL IN THE CARPUS AT THE LEVEL OF THE HOOK OF THE HAMATE. DO YOU SEE THE HOOK? NOTE THE POSITIONS OF THE RADIAL AND ULNAR ARTERIES AT THIS LEVEL AND APPRICIATE HOW THEY CONTRIBUTE TO THE PALMAR ARCHES IN THE HAND RADIAL ARTERY HERE ARE THE SUPERFICIAL AND DEEP ULNAR ARTERIES AND NERVES

HERE IS AN INJECTION OF A RADIAL ARTERY FROM AN ANGIOGRAM. NOW THAT YOU HAVE SEEN ITS APPEARANCE ON AXIAL IMAGES, TRY AND APPRECIATE ITS RELATIONS SHIPS ON THIS ANGIOGRAPHIC IMAGE

HERE IS AN INJECTION OF A ULNAR ARTERY FROM AN ANGIOGRAM. NOW THAT YOU HAVE SEEN ITS APPEARANCE ON AXIAL IMAGES, TRY AND APPRECIATE ITS RELATIONS SHIPS ON THIS ANGIOGRAPHIC IMAGE